肾结石患者经皮肾镜取石术后感染性并发症影响因素及干预对策

Factors influencing infectious complications after percutaneous nephrolithotomy in patients with kidney stones and intervention strategies

目的 分析肾结石患者经皮肾镜取石术(PCNL)后发生感染性并发症的影响因素。方法 回顾性分析2017年1月~2023年8月于西安交通大学第二附属医院行一期PCNL治疗的肾结石患者502例,根据患者是否出现感染分为感染组(n=45)与未感染组(n=457)。对两组年龄、性别、合并基础病、体质量指数(BMI)、结石大小、位置、有无肾积水、术前中段尿细菌培养、结石培养结果、术前肾功能等临床资料以及手术时间、通道数等术中指标进行比较,采用logistic多因素回归分析感染影响因素。结果 剔除共线性后,手术时间≥100 min、结石长径≥3 cm、感染性结石、术前尿细菌培养阳性和结石培养阳性是PCNL术后感染的独立风险因素(P<0.05)。结论 对于手术时间长、感染性结石、尿细菌培养阳性和结石细菌培养阳性的大直径肾结石患者应注重围术期管理,加强术后护理以降低术后感染并发症的发生。

Objective To analyze the influencing factors of infectious complications in patients with kidney stones after percutaneous nephrolithotomy(PCNL)and summarize intervention strategies.Methods A retrospective analysis was conducted on the clinical data of patients with kidney stones who underwent primary PCNL treatment in our hospital from January 2017 to August 2023.The patients were divided into an infected group and an uninfected group based on whether they had infection.Compare clinical data such as age,gender,comorbidities,BMI,stone size,location,presence or absence of hydronephrosis,preoperative mid-stage urine bacterial culture,stone culture results,preoperative renal function,surgical time,number of channels,and other intraoperative indicators between two groups.Use logistic multiple regression analysis to analyze the influencing factors of infection.Results After removing collinearity,surgical time≥100 minutes,stone diameter≥3 cm,infectious stones,positive preoperative urine bacterial culture,and positive stone culture were independent risk factors for postoperative infection in PCNL.Conclusion For patients with large diameter kidney stones who have a long surgical time,infectious stones,positive urine bacterial culture,and positive stone bacterial culture,perioperative management should be emphasized,and postoperative care should be strengthened to reduce the occurrence of postoperative infection complications.